And a Little Bit More About Medicine

Blog 9: First Day of Urban Rotations. Quito, Ecuador.

The IESS are everywhere! Sticker found on the toilet paper dispenser in a bathroom in Quito.

Today was the first day of urban rotations (read: Quito city hospitals). We went to the IESS Batan Hospital to shadow a family practitioner, Dr. Alvear, who was amazingly kind and accommodating, and didn’t mind us asking questions or simply giving us quick pointers as he was seeing patients. Because he teaches at three different universities, his schedule runs from 7 am to 11 am in the clinics. I noticed that in the urban setting, doctors are very a) packed with patients waiting for their turn to see the physician and b) there is significant and meticulous charting involved as well (which we have in the US). We saw a few patients:

Patient 1: An elderly lady, over 80 years old, but still looked like she took good care of herself and was actually quite glamorous. She was living with a lot of other problems, like hypertension and hemorrhoids, but her specific complaint was very interesting. The doctor eventually deduced that she had orthostatic/postural hypotension (ortostatismo), which fitted with her complaints of syncope or sudden fainting spells. He prescribed a tilting table test (mesa basculante), which is meant to keep track of patients’ blood pressure, pulse, and other symptoms while the patient is placed on a tilting table with foot support. This test is only applicable when cardiovascular diseases aren’t suspected of being the cause of syncope.

Patient 2: A middle-aged woman with diabetes who came in with complaints of stomachache and nausea. The doctor prescribed Lactulosa, which is a synthetic form of sugar that works by osmosis in the colon to help clean the digestive tract and relieve constipation.

The third patient had hypertension and diabetes as well, and came in with complaints of a dry throat, but before the doctor could diagnose further, we then headed out with the nurses to do a house visit (visita domicilios). This domicilio visit was a little bit different from Chone’s in that a physician did not accompany the team of nurses this time.

The patient was a very elderly man living in his daughter’s house who was disabled from muscle atrophy. The story is astonishing: according to the nurses, the old man used to live alone, and would lie in bed all day, and as a result, his muscles wasted away and now, he’s confined to a wheelchair and has ulcers and broken skin all over his body, all in varying colors of dulled red. The nurses came to clean the ulcers (one on his tailbone, where we could actually see his tailbone; that’s how little muscle he had left; and one on each of the soles of his feet).

I was told that this apartment was a typical example of a lower-middle class family, and the standard of living compared to the homes in Chone was astonishing. There were wood tables, clean running hot water, and electronic appliances like television and a microwave. While the dressings were being changed, one of my fellow pre-med students asked the daughter what she thought of Cotopaxi (the volcano that’s been threatening to erupt and had already spewed ashes all over Quito on Friday). The woman said that it was dangerous, of course, and that it was a shame and all of that, and well, anyways, it’s to be expected, isn’t it, because of the entire mess with Correa and Ecuadorian politics and the volcanoes had always erupted when politics became a mess. I was astonished. This woman had attributed natural disasters to political problems?! She definitely wasn’t the only one to do so, though — I’ve heard this from multiple people around Ecuador and my friends have heard the same from the other locals. This might be because the Ecuadorian people are externally motivated — unlike Americans, who have an idea of what they want and then choose politically based on what fits their ideals, Ecuadorians are more of the this-sounds-like-a-good-idea and then choose based on their external environment.

After our rotations, we took public transportation (public transportation in Ecuador is amazing, by the way) back to our part of Quito, and then, because I was still feeling nauseous from altitude sickness, I just had some soup and then took a nap before class. Traveling is always exhausting and I still hadn’t recovered from the very long weekend we had, plus Quito is at like 9,350 feet (2,850 m) above sea level, which I just found out is the HIGHEST capital city in the WORLD. Geezus. No wonder we’ve all been feeling nauseous since we’ve gotten back from Chone.

And then, after getting lost in the very many streets of Quito, I found my way to the Amazing Andes Spanish School, where we take our formal Spanish lessons for 3 hours a day. Today we had an absolutely fascinating discussion on abortion in Ecuador, although we were also talking about abortion in general. I will definitely post another piece later on Ecuadorian abortions. We also found out, during class, that right next to Chone are some famous Incan ruins, and we were there for two weeks and had NO FREAKING IDEA. Goddamn. We could have gone to see INCAN RUINS.

Ah well. For travelers out there, who plan on going to the coast, definitely check out the beaches and the Galapagos and Isla de la Plata, but also make sure to ask about the Incan ruins. Because, well, damn. Culture.

xoxo,

Diana